National PPO plans

A national PPO widens the network. It does not put every hospital on a contracted rate. Emergency care, a facility you chose, and a clinician who does not take the plan can still produce an out-of-network bill.

Use the explanation of benefits as the plan’s version of the visit, and the itemized statement as the hospital’s version. The figure review compares the hospital’s lines with the hospital’s total. Your share, if you are in-network, is the patient-responsibility column on the explanation of benefits.

If a clinician at an in-network hospital was out-of-network, run the balance-bill check before you pay that clinician’s bill.